Summary Report for FSPSAs Initiated During the Report Period Center: 04
This report shows the total number of units/fees for FSPSAs initiated during the report period.
(i.e., start date of service authorization occurs during the report period). This report does not
represent all FSPSAs that overlap the report period. Note that service authorization periods may
range from 1 to 12 months and may vary in intensity from child to child.
FSPSAs starting between: 04-01-20 and 06-30-20 Date of Report: 07-20-20 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 1754 FSPSA's found
Services Cpt Code Number of Number of Total Units Total Cost of Avg Fee
Children Records Authorized Auth Services Per Unit Auth
Service Coordination, Class # 01
SCONLY-SCONLY *SERVICE COORDINATION ONLY 34 38 20.388889 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 34 38 20.388889 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
ASTE -ASTE ASSISTIVE TECHNOLOGY EVAL 7 7 1.961112 $95.1200 $48.5000
AUD -92626 EVAL OF AUD REHAB STATUS 1 1 1.000000 $56.4900 $56.4900
OCTH -97167 OT EVAL HIGH COMPLEXITY 80 84 18.555558 $947.2700 $51.0500
PSTH -97162 PT EVAL MODERATE COMPLEXITY 2 2 0.766667 $39.1400 $51.0500
PSTH -97163 PT EVAL HIGH COMPLEXITY 58 59 22.503966 $1148.8200 $51.0500
SPCH -92522 EVAL OF SPCH SOUND PROD 1 2 0.355556 $18.1500 $51.0600
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 49 52 10.949998 $558.9900 $51.0500
SPCH -92610 EVAL OF ORAL,PHARYNGEAL SWALLOWING 5 5 1.227778 $54.7000 $44.5500
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Subtotal (Total Children Is Unduplicated) 144 212 57.320635 $2918.6800 $50.9200
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 7 18 5.249996 $262.4800 $50.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 3 4 2.400000 $120.0000 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 3 4 3.322222 $166.1100 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 1 1 0.100000 $2.5000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 1 1 1.011111 $50.5600 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 3 3 1.200000 $30.0000 $25.0000
EIGF -T1027TTSC EI GROUP SESSION BY EI PROF 83 120 514.142861 $12853.5400 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 463 499 3330.857152 $166542.8200 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 1 1 8.142857 $407.1500 $50.0000
NESF -99600 NATURAL ENVIRONMENT SUPPORT FEE 449 490 3204.850007 $32048.5000 $10.0000
OCCT -97530 OT SESSION BY LICENSED OT 68 74 383.999996 $27432.9700 $71.4400
OCCT -97530HM OT SESSION BY OT ASST 43 60 227.571423 $13017.1100 $57.2000
PHY -97110 PT SESSION BY LICENSED PT 63 73 357.214283 $25519.4000 $71.4400
PHY -97110HM PT SESSION BY PT ASST 26 35 155.357141 $8880.2200 $57.1600
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 32 35 180.142854 $12869.4000 $71.4400
SPL -92507GT SPL THERAPY SESSION BY LICENSED SLP 1 1 1.714286 $122.4700 $71.4400
SPL -92507HM SPL THERAPY SESSION BY SLP ASST 13 18 64.214285 $3673.0600 $57.2000
SPL -92508 GROUP SPL SESSION PER CHILD 38 53 187.999996 $2609.4500 $13.8800
TELEC -TELEC TELECONFERENCE,PROVIDER TO FAMILY,P 10 14 50.178571 $1856.6200 $37.0000
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Subtotal (Total Children Is Unduplicated) 608 1504 8679.669041 $308464.3400 $35.5400
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Total 1754 8757.378565 $311383.0200 $35.5600
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Number of Children (Unduplicated) With at Least One Authorization 634